Period Promise - Hygiene Cabinet Program Partnership Survey

At Northumberland United Way, we believe that everyone deserves access to menstrual and hygiene products—without shame, stigma, or barriers. Through our newly enhanced Period Promise Program, we are proud to support individuals and communities across Northumberland County with a model grounded in dignity, consistency, and equity.

Our local Period Promise program has created a new method to distribute free menstrual hygiene products by developing our Period Promise and Hygiene Cabinet (H60"xL23 5/8"xD12 3/8"). Our goal is to improve distribution throughout Northumberland County and we are looking for applications from Not-for Profit organizations to house our new branded cabinets. These cabinets will be stocked quarterly with 40 of our new dignity kits (1 month supply for a client) and other hygiene products as they are donated.

This application is to apply to house our Period Promise and Hygiene Cabinet. The Period Promise and Hygiene Cabinet will be restocked quarterly with 40 of our new dignity kits which is a one month supply, and potentially other related hygiene products.

Together, we can build a Northumberland where access to menstrual products is a basic standard of care—not a barrier to opportunity or dignity.

1.Organization Information(Required.)

Organization Name:

Address:

Contact Name:

Phone:

E-mail:

Alternate Contact Name:

Alternate Phone:

Alternate E-mail:

2.What type of organization are you?(Required.)

A charity

Not for profit

Municipality

Unincorporated/Grassroots

3.Charity or Business Number (if applicable)

4.Are you a faith-based organization?(Required.)

Yes

5.Please provide your organization's mission statement and a summary of your programs here so we can better understand your organization.(Required.)

6.Are you a living wage employer?(Required.)

Yes

7.Do you have current DEI policies and/or procedures?(Required.)

Yes

8.Do you provide bilingual service? (This is just to help us understand if you serve clients who speak French)(Required.)

Yes

9.Total number of clients served by your organization:(Required.)

10.Period Promise is a poverty reduction strategy providing menstrual access products to those who are struggling. Help us to understand who the clients are that your agency serves as you've listed above. Please take your best guess and estimate percentages.(Required.)

Teenagers (13 - 19)

Young Adults (20 - 29)

Adults (30-55)

Seniors (55+)

11.In percentages, how many of your total clients are facing the following(Required.)

Housing Security

Food Insecurity

Employment and Financial Insecurity

12.In percentages how many of the people you serve fall into the categories below (recognizing there will be overlap)(Required.)

Indigenous

Newcomers

LGBTQS+

Persons with disabilities

Racialized Communities

Women/Girls

13.Qualitative Description. Is there anything else that you would like us to know about the clients you serve?(Required.)

14.Help us to understand why it would be a benefit to you to house the United Way Period Promise and Hygiene Cabinet at your organization?(Required.)

15.What would be the hours of access to the cabinet?(Required.)

16.Please note this cabinet will remain the property of the United Way Northumberland. Does your location give permission to the United Way to visit, check in and stock the cabinet?(Required.)

Yes

17.There will be quarterly reporting required, and by applying you are agreeing to the following:(Required.)

Meeting to discuss the contract in person

Permission to do promotion that the cabinet is at your organization

Access to restock (Please advise of any special instructions during contract meeting)

Impact Story every quarter (how this is helping clients, do not need to provide specific client details)

Items are only to be added by United Way Northumberland, unless permission is given by United Way Northumberland

Thank you for your interest in being a Period Promise and Hygiene Cabinet location.